A new analysis of 4,909 residents found that candidates who took the exam immediate after residency had an average first-time QE pass rate of 87%, compared with 57% for those who delayed 1 year and just 48% for those who delayed 2 years or more.

PATRICE WENDLING/Elsevier Global Medical News

“This idea of somehow thinking your results are going to improve if you wait a year is not borne out by the information we’ve shown,” study author and ABS associate executive director Dr. Mark Malangoni said in an interview.

While the study identified an association and not cause and effect, Dr. Malangoni and his colleagues suggest that poor performance is “most likely due to a deterioration of knowledge over time.”

That may not sit all that well with the average patient, who likes to think that physicians (like parents and even journalists) get smarter with experience.

Dr. Malangoni explained that one of two things may be going on. Roughly 80% of general surgery residents pursue a fellowship and focus on learning in a very narrow area. So, when they take the QE, which tests a very broad base of surgical knowledge, they may actually be forgetting things because of the narrow focus of their fellowships.

The second scenario is that the candidates start a practice, and the activities and stressors inherent in this new venture, may divert them from maintaining their knowledge base, he said.

Still others attending the recent Central Surgical Association meeting, where the study was presented, suggest that candidates who delay taking the QE may simply be poor learners or poor test takers.

Regression analysis, however, found that the effect was tempered but still significant after controlling for the candidate’s fund of knowledge using ABS In-Training Examination (ABSITE) scores. Undergraduate medical education and post-residency training also did not affect the results.

“There are a lot of reasons why someone might delay taking the examination and some of them are perfectly understandable,” Dr. Malangoni said. “I think the message we’d like to transmit to someone who’s thinking of delaying, is that if you’re able to adequately prepare for the examination, you should take it with that first opportunity right after completing residency because it appears, from what information we have, that that’s your greatest chance of being successful in passing the examination.”